Midazolam versus propofol for long-term sedation in the ICU: a randomized prospective comparison.
OBJECTIVE
To compare the efficacy, safety, and cost of midazolam and propofol in prolonged sedation of critically ill patients.


METHODS
Randomized, prospective study.


METHODS
General intensive care unit (ICU) in a 1100-bed teaching hospital.


METHODS
67 critically ill, mechanically ventilated patients.


METHODS
Patients were invasively monitored and mechanically ventilated. A loading dose [midazolam 0.11 +/- 0.02 (SEM) mg.kg-1, propofol 1.3 +/- 0.2 mg.kg-1] was administered, followed by continuous infusion, titrated to achieve a predetermined sedation score. Sedation was continued as long as clinically indicated.


RESULTS
Mean duration of sedation was 141 and 99 h (NS) for midazolam and propofol, respectively, at mean hourly doses of 0.070 +/- 0.003 mg.kg-1 midazolam and 1.80 +/- 0.08 mg.kg-1 propofol. Overall, 68% of propofol patients versus 31% of midazolam (p < 0.001) patients had a > 20% decrease in systolic blood pressure after the loading dose, and 26 versus 45% (p < 0.01) showed a 25% decrease in spontaneous minute volume. Propofol required more daily dose adjustments (2.1 +/- 0.1 vs 1.4 +/- 0.1, p < 0.001). Nurse-rated quality of sedation with midazolam was higher (8.2 +/- 0.1 vs 7.3 +/- 0.1 on a 10-cm visual analog scale, p < 0.001). Resumption of spontaneous respiration was equally rapid. Recovery was faster after propofol (p < 0.02), albeit with a higher degree of agitation. Amnesia was evident in all midazolam patients but in only a third of propofol patients. The cost of propofol was 4-5 times higher.


CONCLUSIONS
Both drugs afforded reliable, safe, and controllable long-term sedation in ICU patients and rapid weaning from mechanical ventilation. Midazolam depressed respiration, allowed better maintenance of sedation, and yielded complete amnesia at a lower cost, while propofol caused more cardiovascular depression during induction.
Weinbroum
A A
AA
Departments of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Israel.
Halpern
P
P
Rudick
V
V
Sorkine
P
P
Freedman
M
M
Geller
E
E
D000328:Adult; D016638:Critical Illness; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome; D015300:Ventilator Weaning
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol